Chapter 4: Control Bleeding

4.1 Introduction to Bleeding

Haemorrhage, or bleeding, occurs when blood vessels within the body tissues are damaged, leading to blood loss that can often be identified through visible bleeding or bruising. This condition can be life-threatening, depending on the location and severity of the injury. For instance, a fracture of the humerus may result in an estimated blood loss of 500–750 ml. Therefore, bleeding control is considered a top priority in FA. Bleeding can be categorised as either internal or external, and it is further divided into three types: venous, capillary, and arterial. While each type requires specific management techniques, the fundamental principles of bleeding control remain the same.

4.2 Types of Bleeding
4.2.1 Arterial Bleeding

Arterial bleeding represents the most critical and life-threatening form of haemorrhage. It typically occurs following a penetrating wound, blunt force injury, or damage to major organs and blood vessels. Unlike other types of bleeding, arterial blood has distinct characteristics. It appears bright red due to its high oxygen content and is expelled in rhythmic spurts that match the heartbeat. Controlling this form of bleeding is challenging, as the strong pressure generated by the heart prevents the blood from clotting or stopping quickly.

The techniques for controlling the arterial type of bleeding are as follows:

1. Perform the DRSABC assessment.
2. Clean the wound using sterile solution or clean water with a sterile gauze pad or a clean cloth.
3. Apply firm pressure directly on the bleeding site using a gloved hand and a piece of sterile gauze. If there is no sterile gauze available, you may use a clean cloth instead.
4. If the first layer of gauze/cloth is soaked with blood, do not remove it, instead, add another layer and continue to press the wound. Removing the first layer may disturb the blood clotting process.
5. If the bleeding slows or stops, the wound should then be secured with a sterile dressing and bandage to maintain continuous pressure.
6. For bleeding from an artery in the arm or leg, raising the injured limb above heart level may help reduce blood flow.
7. If bleeding persists despite these measures, the final option is to place a tourniquet above the site of injury to control the blood loss.

4.2.2 Venous Bleeding

Venous bleeding is typically less severe than arterial bleeding, however, it can still become life-threatening depending on the location of the injury and the size of the wound. This requires immediate medical attention. Since the blood originates from a vein, it appears darker in colour due to its lower oxygen content. Unlike arterial bleeding, venous bleeding is not driven by high pressure, so the blood escapes in a steady, continuous flow rather than in forceful spurts.
The techniques for controlling a venous bleed are similar to those for managing an arterial bleed.

4.2.3 Capillary Bleeding

Capillary bleeding typically occurs when the skin is damaged and is the most common type of bleeding. Unlike arterial bleeding, which spurts, or venous bleeding, which flows steadily, capillary bleeding seeps slowly from the injured area. This form of bleeding is the least dangerous and the simplest to manage, as it originates from surface-level blood vessels rather than deeper structures within the body.

The techniques for controlling the capillary bleed are as follows:

1. Clean the wound with soap and water or using a cell-safe cleansing agent.
2. If necessary, irrigate the area under pressure to remove dirt or foreign material, which helps reduce the risk of infection.
3. To complete the process, place a sterile dressing over the wound and apply firm pressure with a gloved hand, as this is usually enough to stop the bleeding.

The characteristics of arterial, venous, and capillary bleeding are as follows: